902 KAR 22:030. Midlevel health care practitioner.

 

      RELATES TO: KRS 216.900-216.930

      STATUTORY AUTHORITY: KRS Chapter 13B, 216.920, 216.925

      NECESSITY, FUNCTION, AND CONFORMITY: KRS Chapter 216 mandates that the Kentucky Board of Family Health Care Providers promulgate administrative regulations necessary to implement their duties and responsibilities. The administrative regulation responds to provisions of KRS 216.920 which requires the Kentucky Board of Family Health Care Providers to certify and recertify midlevel health care practitioners; develop and administer qualifying examinations for midlevel health care practitioners; identify continuing education requirements for midlevel health care practitioners.

 

      Section 1. Definition. "Midlevel health care practitioner (MAP)" means a person certified by the Kentucky Board of Family Health Care Providers to provide limited management of chronic conditions to patients in a licensed network following treatment protocols reviewed and approved by the board pursuant to KRS 216.925.

 

      Section 2. Application for Certification. (1) The application form as shown in these administrative regulations for the general practice of midlevel health care practitioners (MLPs) shall be completed in its entirety by all applicants.

      (2) The application forms shall be obtained through the Kentucky Board of Family Health Care Providers, c/o Division of Vital Records and Health Development, Department for Public Health, 275 East Main Street, Frankfort, Kentucky 40621.

      (3) The application shall be executed and sworn before a notary and returned to the Kentucky Board of Family Health Care Providers with a postmark of at least sixty (60) days prior to the scheduled examination with the fee of fifty (50) dollars.

      (4) The Kentucky Board of Family Health Care Providers may reject an application for the following reasons:

      (a) Applicant has been convicted of a misdemeanor involving moral turpitude or a felony;

      (b) Applicant has had a health care profession license or certificate denied or revoked in any state or territory;

      (c) Applicant has an addiction to alcohol or any other chemical substances;

      (d) Applicant has misrepresented any facts on the application;

      (e) Applicant has failed to provide additional information requested by the Kentucky Board of Family Health Care Providers;

      (f) Applicant has not properly completed or sworn to the information to meet all the requirements pursuant to KRS Chapter 216.

      (5) The Kentucky Board of Family Health Care Providers shall notify the candidate of acceptance or rejection of the application and/or date, time, place of the examination at least thirty (30) days prior to the examination.

 

      Section 3. Approved Qualifying Examinations. (1) The examination for certification as a midlevel health care practitioner shall consist of a written portion and a clinical/skills practicum portion.

      (2) The qualifying examination for certification as a midlevel health care practitioner shall consist of the following components as approved by the Kentucky Board of Family Health Care Providers:

      (a) The written portion of the examination shall consist of items based on medical treatment protocols developed and approved by the Kentucky Board of Family Health Care Providers.

      (b) The clinical practicum portion of the examination shall test the applicant's skills and shall be based on the medical treatment protocols developed and/or approved by the Kentucky Board of Family Health Care Providers.

      (c) A score of seventy (70) percent shall be achieved on the written portion of the qualifying examination and a score of 100 percent shall be achieved on the clinical/skills portion of the examination for certification as a midlevel health care practitioner.

      (3) The board shall recognize the national or state qualifying examinations for certification or licensure of advanced registered nurse practitioners, physician assistants and registered nurses as the qualifying examination for the certified midlevel health care practitioner.

 

      Section 4. Qualifying Examination Administration. (1) Examination sites and examination frequency shall be designated by the Kentucky Board of Family Health Care Providers and published annually.

      (2) There shall be no limit on the number of times a candidate can take the examination for certification.

      (3) The candidate shall notify the Kentucky Board of Family Health Care Providers if a new test date is desired.

 

      Section 5. Initial Certification of Midlevel Health Care Practitioners. (1) To be certified by the Kentucky Board of Family Health Care Providers as a midlevel health care practitioner, a person shall:

      (a) Be a health care professional who, by license or certification directly deals with physical or psychological illness of a patient;

      (b) Submit a completed application with the required fee;

      (c) Be of good character and reputation;

      (d) Meet the requirement for application pursuant to KRS 216.925;

      (e) Have passed an examination approved by the Kentucky Board of Family Health Care Providers.

      (2) The certified midlevel health care practitioner shall practice only in licensed networks following the guidelines pursuant to KRS 216.925.

      (3) Certification shall begin on or before July 1, 1992, and completion of the qualifying examination is required every five (5) years thereafter.

      (4) Interagency cooperation.

      (a) The board shall notify in writing other health care profession licensing or certifying agencies of an individual's additional certification as a midlevel health care practitioner.

      (b) The board shall request that if the other health care profession licensing or certifying agency revokes the midlevel health care practitioner's license or certification, that notice of the revocation be sent to the Cabinet for Health Services within ten (10) days of the agency's action.

 

      Section 6. Recertification of Midlevel Health Care Practitioners. (1) The application form as shown in these administrative regulations for the general practice of midlevel health care practitioners (MLPs) shall be completed in its entirety by all applicants.

      (2) The application forms shall be obtained through the Kentucky Board of Family Health Care Providers, c/o Division of Vital Records and Health Development, Department for Public Health, 275 East Main Street, Frankfort, Kentucky 40621.

      (3) The application shall be executed and sworn before a notary and returned to the Kentucky Board of Family Health Care Providers with a postmark of at least sixty (60) days prior to the end of the licensure period with the fee of fifty (50) dollars.

      (4) The Kentucky Board of Family Health Care Providers may reject an application for the following reasons:

      (a) Applicant has been convicted of a misdemeanor involving moral turpitude or a felony;

      (b) Applicant has had a health care profession license or certificate denied or revoked in any state or territory;

      (c) Applicant has an addiction to alcohol or any other chemical substances;

      (d) Applicant has misrepresented any facts on the application;

      (e) Applicant has failed to provide additional information requested by the Kentucky Board of Family Health Care Providers;

      (f) Applicant has not properly completed or sworn to the information to meet all the requirements pursuant to KRS Chapter 216;

      (g) Applicant has failed to complete mandatory education requirements.

      (5) The midlevel health care practitioner shall provide evidence of having completed the required ten (10) medical education hours annually for recertification.

      (6) The Kentucky Board of Family Health Care Providers shall notify the candidate of acceptance or rejection of the application and/or date, time, place of the examination at least thirty (30) days prior to the examination.

 

      Section 7. Revocation of Certification. (1) A midlevel health care practitioner's certification may be revoked for the following reasons:

      (a) Conviction of a misdemeanor involving moral turpitude or felony;

      (b) Any other health care profession license or certificate is denied or revoked in any state or territory;

      (c) Addiction to alcohol or any other chemical substances;

      (d) Misrepresentation of any facts during the application, testing and certification process or at any time while practicing as a midlevel health care practitioner in a licensed network;

      (e) Failure to complete the ten (10) required medical education hours recognized by the board.

      (2) The board shall request in writing to the supervising physician of the licensed network where the midlevel health care practitioner is employed that notification be provided to the designated Cabinet for Human Resources staff of the occurrence of any of the above.

      (3) Administrative hearings due to appeal or denial shall be held in accordance with 902 KAR 1:400.

 

      Section 8. Mandatory Continuing Education Requirements. (1) Any human immunodeficiency virus education courses shall be in accordance with 902 KAR 2:160, Human immunodeficiency virus education continuing education for professionals.

      (2) Courses shall utilize organized learning experiences through personal professional presentations or educational programs meeting the criteria for AMA Category 1 or the Kentucky Board of Nursing requirements.

      (3) Continuing education courses approved by any other health care profession licensing or certifying agency shall be considered for relevance to the role of midlevel health care practitioners and for approval as continuing education courses for midlevel health care practitioners by the Kentucky Board of Family Health Care Providers.

      (a) The potential provider of continuing education requirements for the midlevel health care practitioner shall request an application for approval as a provider and the board shall assign the potential provider of continuing education a permanent, nontransferable number. The provider of continuing education number shall be used to identify all communications, offering announcements, records, and reports.

      (b) Applications for approval as a provider of continuing education may be submitted at any time during the year.

      (c) If the potential provider of continuing education meets the board's standards and criteria, approval shall be granted.

      (4) At the time of recertification the certified midlevel health care practitioner shall submit to the Kentucky Board of Family Health Care Providers in the form of certificates, examinations, signed forms, etc., proof of completion of ten (10) approved medical education hours per year to the following address: Kentucky Board of Family Health Care Providers, c/o Division of Vital Records and Health Development, Department for Public Health, 275 East Main Street, Frankfort, Kentucky 40621.

(See Forms on following two pages)

      I hereby submit a photograph of myself taken within the past six (6) months. Further, I swear that the statements herein contained are strictly true in every respect; that I have never been convicted of a felony or a misdemeanor involving moral turpitude; that I am not addicted to alcohol or other chemicals; that I have read and understand this affidavit; and that if this petition is granted and certification is subsequently issued to me, I will comply with the laws governing the practice of midlevel health care practitioner in the Commonwealth of Kentucky and do my utmost to uphold and maintain professionalism in the health care field.

 

Signature of Applicant:

Signed and sworn to before me this ______ day of _____, 19__.

 

Official designating officer administering oath:

On this ________ day of _____, 19__, personally appeared before me, referred to in the foregoing application for admission to an examination to demonstrate his qualifications to practice as a midlevel health care provider in the Commonwealth of Kentucky. I hereby certify that the accompanying photograph is that of the person making this application for examination for certification to practice as a midlevel health care provider.

 

Signature:

Official Title:

 

                                                                                 AFFIDAVIT

State of:

County of:

 

(Attach photograph in space provided on form.)

 


 

Examination Date _________________________                                                                       Application No. ________________________

 

                APPLICATIONS MUST BE TYPED OR FILLED OUT IN INK

                                 APPLICATION FOR CERTIFICATION                                                                 CHECK APPROPRIATE BOX

             KENTUCKY BOARD OF FAMILY HEALTH CARE PROVIDERS                                            

                               FOR CERTIFICATION TO PRACTICE                                                               □  Applicant for Examination

                                        Commonwealth of Kentucky                                                                        □  Certified or licensed PA, ARNP,

                                          Frankfort, Kentucky 40621                                                                               RN applicant for certification

                         AN EQUAL OPPORTUNITY EMPLOYER M/F/H                                                         □   Recertification

                                                                                                                                                                                                                                         

 

To the Kentucky Board of Family Health Care Providers:

 

I hereby apply for permission to take an examination at the next scheduled examination to demonstrate my qualifications to practice as a midlevel health care practitioner in the Commonwealth of Kentucky.  I enclose herewith the required fee of fifty ($50) dollars (certified check or money order) and furnish below the information to which my affidavit is added at the end.

 

 

Social Security No. ____________________________                       Home Phone No.________________Work Phone No._______________

 

      □   Mr.

                              _________________________________________________________________________________________________

                                                  Last Name                            First Name                              Middle Name                    Maiden Name (if any)

      □   Ms.

      Address:         _________________________________________________________________________________________________

                                                  Street, R.F.D., or Box No.               State                            City                                   Zip Code

 

      Date of Birth:  _________________________________

                                    Month               Day            Year

 

 

PREVIOUS EDUCATION

 

                    EDUCATION AND TRAINING: Please circle highest grade completed.  college transcripts are required.

                      Grade School               High School                  College                 Graduate School                  Have you passed a G.E.D. Test?   Yes        No        If yes

                  1  2  3  4  5  6  7  8           9  10  11  12                1  2  3  4                       1  2  3  4                        If yes attach a copy of the scores or the G.E.D. certificate

 

 

 

School

 

 

Name and Address of School

 

Dates Attended

 

Date

of

Graduation

Number

of Hours

 

Fields of Study

 

Degree, Diploma, or Certificate Earned

 

From

 

To

Com-pleted

Now Earning

 

Major

 

Minor

 

 

High School

 

 

 

 

mo/yr

 

 

 

 

Diploma:

Yes

No

 

Graduate College or University

 

mo/yr

mo/yr

mo/yr

*

*

 

 

Degree:

 

Graduate College or University

 

mo/yr

mo/yr

mo/yr

*

*

 

 

Degree:

 

Vocational, Business, Technical

 

 

mo/yr

mo/yr

Clock hours weekly:

Clock hours completed

 

 

Must provide copy of certificate

 

Certificate Earned:

 

Apprentice-ship

Type:

mo/yr

mo/yr

Length:

Journeyman:

Yes

No

Must provide copy of certificate

      *Please indicate if quarter hours

 

PREVIOUS EXPERIENCE

LICENSES OR CERTIFICATES; Date, number and sources of any previous licenses to practice in any health field in any state or territory.

 

 

Name of Trade or Profession

Original License

Issue Date

Current License

Expiration Date

 

Name and Address of Licensing Agency

License:

 

 

 

License:

 

 

 

License:

 

 

 

 

EMPLOYMENT HISTORY:  Begin with your present or most recent job and list fully and accurately the details of each job you have held.  Include Volunteer work.  If you moved to a different position within the same organization so that your duties changed, then describe that as a separate job.  Resumes must follow the format shown below.   PLEASE NOTE IF YOU WORKED UNDER A DIFFERENT NAME.  (Attach additional sheets if necessary).

                                      Mo.    Day    Yr.              Mo.     Day     Yr.

Employed:        From:  ______________     To:_______________

Title of Position  _______________________________________

Reason for leaving _____________________________________

Name of Employer _____________________________________

Address _____________________________________________

                                                Street

____________________________________________________

           City                                 State                          Zip

Name and title of you immediate supervisor  _________________

____________________________________________________

 

A description of jobs MUST be given:

 

Mo.    Day    Yr.              Mo.     Day     Yr.

Employed:        From:  ______________     To:_______________

Title of Position  _______________________________________

Reason for leaving _____________________________________

Name of Employer _____________________________________

Address _____________________________________________

                                                Street

____________________________________________________

           City                                 State                          Zip

Name and title of you immediate supervisor  _________________

____________________________________________________

 

A description of jobs MUST be given:

Mo.    Day    Yr.              Mo.     Day     Yr.

Employed:        From:  ______________     To:_______________

Title of Position  _______________________________________

Reason for leaving _____________________________________

Name of Employer _____________________________________

Address _____________________________________________

                                                Street

____________________________________________________

           City                                 State                          Zip

Name and title of you immediate supervisor  _________________

____________________________________________________

 

A description of jobs MUST be given:

 

If you have ever been examined and refused a license as a health care professional or if you have ever had a health care professional license canceled or revoked, give full particulars.

____________________________________________________________________________________________________________________

____________________________________________________________________________________________________________________

 

I hereby submit a photograph of myself taken within the past six months.  Further, I swear that the statements herein contained are strictly true in every respect; that I have never been convicted of a felony or a misdemeanor involving moral turpitude; that I am not addicted to alcohol or other chemicals; that I have read and understand this affidavit; and that if this petition is granted and certification is subsequently issued to me, I will comply with the laws governing the practice of midlevel health care practitioner in the Commonwealth of Kentucky and do my utmost to uphold and maintain professionalism in the health care field.

____________________________________________________________________________________________________________________

(Signature of applicant)

Signed and sworn to before me this ________________ day of _______________________, 19______

____________________________________________________________________________________________________________________

(Official designating officer and administering oath)

 

On this _________day of ___________________, 19 _______, personally appeared before me, referred to in the foregoing application for admission to an examination to demonstrate his qualifications to practice as a midlevel health care provider in the Commonwealth of Kentucky.  I hereby certify that that the accompanying photograph is that of the person making this application for examination for certification to practice as a midlevel health care provider.

 

Signature __________________________________________________

Official Title ________________________________________________

                                                                                         AFFIDAVIT

State of ___________________________________________________

County of  _________________________________________________

 

(Attach photograph in space below.)

 

 

      (18 Ky.R. 2502; Am. 2857; 2921; eff. 3-26-1992; 22 Ky.R. 2428; eff. 8-1-1996.)